Various types of specialized forceps, clamps, and other surgical instruments have been developed over the years for use in performing specific surgical operations, and in many cases the configuration and construction of such instruments has been based not only on anatomical considerations but also on the importance of providing the surgeon with tactile information essential in achieving proper control over such an instrument. Thus, forceps used for removal of kidney stones generally have angular shank portions of minimal length so that the closed jaws of such an instrument can be readily inserted into the kidney through an incision in the renal pelvis, and the tips of the closed jaws may then be used as a probe to help the surgeon locate the stones requiring removal. Visual aids such as fluoroscopy and x-radiography are often used, but a surgeon manipulating such an instrument must nevertheless rely primarily on tactile sensitivity to locate, grasp, and remove the calculi.
More recently, endoscopic instruments have been developed to provide surgeons with an internal view of the organ or body passage requiring treatment, such endoscopes typically having channels through which a miniaturized forceps, commonly called flexible instruments, are inserted and advanced. While such a system does provide the surgeon with an internal view of the operative site, miniaturization reduces the effectiveness of the flexible instrument for many functions such as, for example, grasping and removing larger size kidney stones. Moreover, the flexibility of the grasping (or cutting) instrument, and the distance between its jaws and the remote handles held by the surgeon, all but eliminate the transmission of tactile signals and require that almost complete reliance be placed on endoscopic observation in performing surgical manipulations. Not only are the surgeon's hands spaced well away from the distal end of the endoscope and the jaws of the instrument, but they are normally fully occupied by the manipulations required at the proximal end of the equipment. One hand is commonly used to hold and direct the endoscope while the other is used to direct and operate the flexible instrument and also to control the irrigation system--all such manipulations occurring at the proximal end of the endoscopic system, well away from the organ or body part undergoing surgical treatment. Any tactile feedback is minimal because of the lack of rigidity of the instrument and the distance between its jaws and operating controls.
References illustrative of the state of the art are U.S. Pat. Nos. 3,960,143, 4,046,149, 4,046,150, 4,043,323, and 3,413,976. Other publications are Tsuchida, S., A New Operative Fiberpyeloscope, Journal of Urology, 117:643-5 (May 1977), Olinger, C. P. & R. L. Ohlhaber, Eighteen-Guage Needle Endoscope with Flexible Viewing System, Surg. Neurol. 4:537-8 (1975), Stotter, L., H. J. Wiendl, & B. Ultsch, An Improved Flexible Cholangioscope, Endoscopy 7:150-3 (1975), Gittes, R. S., Operative Nephroscopy, Journal of Urology, 116:148-52 (1976), Miki, M., Y. Inaba, & T. Machida, Operative Nephroscopy with Fiberoptic Scope: Preliminary Report, Journal of Urology, 119:166-8 (February 1978).
An object of this invention therefore lies in providing an endoscope assembly and surgical instrument which allow a surgeon to use both hands at the surgical site, thereby providing maximum tactile input through hand contact with the organ and the surgical instrument used to enter that organ, while at the same time providing endoscopic visualization of the interior of the organ and the tip action of the instrument involved. A further object is to provide a system which allows a surgeon to use an instrument having greater holding capacity and effectiveness than a miniaturized intraluminal grasping instrument, and which also provides the surgeon with both tactile input and visual confirmation. Another object is to provide an endoscopic attachment for a rigid surgical instrument having jaws for probing, grasping, and/or cutting, the attachment being removable when not needed, or when its use is required with another related type of instrument. A still further object is to provide a low profile endoscopic attachment which contains flexible transmitting means for illuminating and transmitting images, and which also provides a passage for irrigation of the operative site.
In brief, the instrument used in the combination of this invention may be any of a variety of specialized instruments used for probing and grasping or, in some cases, cutting, which are designed to be held and operated by one hand and which provide the surgeon with a high level of tactile input. For that purpose, such an instrument should have a handle or shank portion of rigid construction. For example, where the instrument is to be used for nephrolithotomy or phelolithotomy with calyceal stone extraction, the instrument may be a modified version of conventional Ray or Randall forceps. Such instruments are rigid enough to be precisely manipulated by the surgeon's hand in close proximity to the kidney (preferably with the other hand holding and manipulating the kidney), while providing maximum tactile sensitivity and sufficiently greater capability for grasping and removing larger stones (those having a diameter greater than about 0.8 centimeters) as well as stones of smaller size.
The endoscope assembly includes an elongated flexible cable equipped at one end with an eyepiece or other viewing means and at the other with an optical head. Only the head is directly and externally connected to the instrument, such rigid connection being made to the instrument's neck portion adjacent the jaws thereof. The cable transmits images or image-producing signals from the illuminated operative site at the head back to the viewing means so that the surgeon will have visual confirmation of the action of the instrument's working end as well as direct tactile input transmitted through the rigid handle or shank of the hand-held instrument.
In the particular embodiment disclosed, the connection between the optical head and the instrument is releasable, the head being equipped with one or more spring clips for detachably engaging the instrument's neck portion. The head is generally crescent-shaped in cross section so that its contour complements that of the instrument. A coherent optic bundle extends from the head and through the flexible cable to the eyepiece for providing the surgeon with visual confirmation of the instrument's tip or jaw action which, as already indicated, is also confirmed by direct tactile input. The illuminating means may take the form of a ligh-transmitting waveguide extending through the cable to illuminate the operative area, such waveguide being connected at its proximal end to a suitable high-intensity light source. Ideally, the cable also provides a flow passage for the delivery of fluid (liquid or gas) for irrigation or other purposes, the flow passage and the illuminating means being disposed on opposite sides of the coherent image-transmitting waveguide.
A support is provided for holding the eyepiece so that the surgeon's hands are free to remain near the operative site at the distal end of the instrument. The support may take the form of a standard adapted to be mounted upon a floor, table, or other stationary surface, or a headband worn by the surgeon.
Other features, objects, and advantages of the invention will become apparent from the specification and drawings.